The Health Committee met to discuss the rising levels of violence and abuse against healthcare staff in London. The committee heard from various healthcare professionals and union representatives about the causes, impacts, and potential solutions to this growing problem. Key discussions focused on the need for better reporting mechanisms, improved training for staff, and stronger consequences for perpetrators.

Violence and Abuse Against Healthcare Staff in London

The Health Committee convened to address the significant increase in violence and abuse directed at healthcare staff across London. The meeting featured two panels of witnesses, including representatives from the London Ambulance Service (LAS), the Royal College of Nursing (RCN), NHS England, Central London Community Healthcare NHS Trust, UNISON, and retired nurses.

Causes and Impacts of Violence and Abuse

Witnesses highlighted several factors contributing to the rise in incidents. Sabina Ritansi, a retired nurse, pointed to a melting pot of reasons including increased patient frustration due to waiting times, a perceived societal shift towards lower tolerance, and systemic issues within healthcare delivery. Lisa Elliott, Director for London at the RCN, noted that while aggression has always been present, current pressures within mental health services and long waiting times exacerbate patient and relative frustrations, often directed at frontline nursing staff, who are predominantly female.

Data presented by the RCN indicated a 252% increase in inquiries regarding nurses subjected to verbal or physical abuse between 2020 and the present. This abuse included being punched, kicked, spat at, strangled, and subjected to verbal and racial abuse. Emily Jackson, a Clinical Advisor and Paramedic for the LAS, shared a harrowing personal account of sexual assault and threats from a patient, underscoring the severe personal impact of such incidents. Jason Killens KAM, CEO of the LAS, reported that in 2024, 53% of LAS staff experienced some form of violence and aggression in the workplace, with a national 15% rise in such cases across the ambulance sector in the last year. He also noted a 90% increase in patient contacts requiring mental health support.

The Right Care, Right Person initiative was discussed, with general agreement that while the principle is sound, its implementation has led to operational challenges and a shift of problems rather than solutions. Lisa Elliott expressed concern that community nurses are struggling to manage welfare checks previously handled by the police, and that emergency departments are becoming places of safety for individuals with mental health crises, placing undue pressure on nursing staff.

Specific groups are disproportionately affected. Lisa Elliott highlighted that nursing, being a female-dominated profession, means women are more likely to be on the receiving end of abuse. Furthermore, an RCN employment survey revealed that 44% of respondents who were Black or Asian nurses reported experiencing violence and aggression, often linked to their ethnicity. Internationally educated nurses were also noted as being significantly impacted. Jason Killens confirmed that ambulance workers are twice as likely to be assaulted at work compared to the rest of the NHS, and that racially aggravated violence and abuse related to other protected characteristics, including towards LGBTQ+ colleagues, are also issues.

The economic cost of violence against NHS staff was estimated at £1.36 billion in 2020-2021, encompassing sickness absence, employee turnover, and diminished productivity. The psychological impact on staff was also profound, with individuals experiencing trauma, PTSD, anxiety, and in some cases, an inability to return to work.

Reporting Structures and Accountability

A significant theme throughout the discussion was the issue of under-reporting and a lack of trust in the reporting process. Lisa Elliott stated that nurses often perceive that nothing will happen when incidents are reported, leading to a feeling that abuse is swept under the carpet. She called for greater national oversight and accountability for NHS trusts regarding how they handle reported incidents.

Jason Killens highlighted the LAS's efforts to encourage reporting through campaigns like

WorkWithoutFear,

The effectiveness of the NHS England Violence Prevention Reduction standard and the Sexual Safety Charter was debated. While some initiatives have improved internal reporting and support, there was a consensus that violent incidents are still increasing. Jason Killens argued for a shift from a response-focused approach to prevention, advocating for a multi-disciplinary approach involving the CPS, court services, police, and social care. He also suggested exploring international models, such as mandatory custodial sentences for assaults on emergency workers in some Australian states.

Chris Akaluka, a security guard and UNISON representative, stressed the vital but often overlooked role of security staff, suggesting their role could be redefined as NHS constables with greater powers and training to reduce reliance on the police. He highlighted that security staff often lack adequate training for dealing with mental health patients, leading to difficult situations.

Recommendations and Future Actions

Several key recommendations emerged from the discussions:

• Improved Reporting and Accountability: A need for a national framework to oversee how trusts handle reported incidents, ensuring consistency and sharing best practices. There should be clear consequences for trusts that fail to adequately address violence and abuse.
• Enhanced Training and Resources: Tailored training for all frontline staff, including security personnel, on de-escalation techniques, conflict resolution, and cultural intelligence, particularly in diverse areas like London.
• Strengthening the Criminal Justice Response: A call for swifter, proportionate justice and prosecution when deliberate acts of violence and aggression occur, particularly against public sector workers.
• Prevention Focus: A greater emphasis on preventative measures, including public awareness campaigns and addressing the root causes of frustration and violence.
• Support for Vulnerable Staff: Robust support mechanisms for staff, especially when dealing with patients who lack capacity or have mental health conditions, ensuring their safety and well-being.
• Review of Security Roles: A re-evaluation of the role and resourcing of NHS security teams to better equip them for current challenges.
• Data and Intelligence: Improved data collection and analysis to better understand the prevalence and nature of incidents, and to evaluate the effectiveness of interventions.
• Public Health Messaging: The Greater London Authority (GLA) and Transport for London (TfL) should explore greater use of their advertising space for public health campaigns, particularly those aligned with mayoral priorities such as health inequalities.

The committee noted the upcoming introduction of new NHS staff standards, which are hoped to provide greater accountability and consistent data collection across trusts. The discussions underscored the urgent need for systemic change to protect healthcare workers and ensure a safe working environment.